Telehealth Coverage Expanded for Medicare Beneficiaries

A sweeping expansion of telehealth coverage for Medicare beneficiaries is being implemented to aid in the healthcare needs of those with the coronavirus, or COVID-19. The Centers for Medicare & Medicaid Services (CMS) announced in a March 17, 2020, press release that it will make a temporary change in its reimbursement policy for telehealth services. For dates of service (DOS) on or after March 6, 2020, CMS will reimburse physicians providing telehealth services to Medicare patients across the country, with fewer restrictions.

Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.

A range of healthcare providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to Medicare beneficiaries. Beneficiaries will be able to receive telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes.

For an indefinite period of time, CMS will be removing all restrictions surrounding telehealth coverage for Medicare beneficiaries. This means that, for the time being, telehealth coverage will be reimbursed for patients who require telehealth services from within their own homes. Patients may also communicate with providers with a more expansive range of communication methods, including the use of their smartphone for face-to-face interaction.

Medicare beneficiaries will be able to receive various services through telehealth including common office visits, mental health counseling, and preventive health screenings. This will help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital which puts themselves or others at risk.

This change broadens telehealth flexibility without regard to the diagnosis of the beneficiary because at this critical point it is important to ensure beneficiaries are following guidance from the CDC including practicing social distancing to reduce the risk of COVID-19 transmission. This change will help prevent vulnerable beneficiaries from unnecessarily entering a healthcare facility when their needs can be met remotely.

Telehealth services covered under this new waiver will allow healthcare workers other than physicians to provide telehealth services to patients. Some of these additional healthcare providers include nurse practitioners, clinical psychologists, and licensed clinical social workers. The type of visit a patient may receive through telecommunication with their provider include, but are not limited to:

  • Common office visits
  • Mental health counseling
  • Preventative health screenings

As part of this announcement, patients will now be able to access their doctors using a wider range of communication tools including telephones that have audio and video capabilities, making it easier for beneficiaries and doctors to connect. Clinicians can bill immediately for dates of service starting March 6, 2020.

Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services. Medicare coinsurance and deductible still apply for these services. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

Medicaid already provides a great deal of flexibility to states that wish to use telehealth services in their programs. States can cover telehealth using various methods of communication such as telephonic, video technology commonly available on smartphones and other devices. No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.